Periprosthetic shoulder fracture repair

ABSTRACT

A periprosthetic fracture repair solution that provides a variety of fracture fixation options should a fracture occur after total hip, knee, or especially a total shoulder arthroplasty, and provides associated methods and apparatus for application of provided fixation. The ability to pre-engineer fracture fixation contingent solutions into humeral components provides for a distinct clinical advantage in the planning and execution for periprosthetic fracture fixation. Said methods and apparatus include targeting devices which allow for intimate association of fixed angle locking screws in pre-drilled holes in an existing prosthetic or other components including additional fixation components. Such apparatus and methods further include the use of alignment devices and other components to allow for ease of repair of periprosthetic fractures utilizing the pre-engineered solutions. Such targeting devices are required in specific circumstances as the prosthetics may prevent x-ray imaging and consequently free hand alignment.

CROSS REFERENCE TO RELATED APPLICATIONS

This application claims priority to a co-pending U.S. patent applicationSer. No. 16/887,033 filed May 29, 2020 by Daniel Nick Segina, James A.Proctor, Jr. and James Arthur Proctor, III for “PERIPROSTHETIC SHOULDERFRACTURE REPAIR, which in turn claimed priority to a co-pending U.S.patent application Ser. No. 16/027,605 filed Jul. 5, 2018 by Daniel NickSegina, James A. Proctor, Jr. and James Arthur Proctor, III for“PERIPROSTHETIC SHOULDER FRACTURE REPAIR (now U.S. Pat. No. 10,687,950)which in turn claimed the benefit of U.S. Provisional Patent ApplicationSer. No. 62/640,378 filed Mar. 8, 2018 by Daniel Nick Segina, James A.Proctor, Jr. and James Arthur Proctor, III for PERIPROSTHETIC SHOULDERFRACTURE REPAIR”, and the benefit of a U.S. Provisional PatentApplication Ser. No. 62/528,675 filed Jul. 5, 2017 by Daniel NickSegina, James A. Proctor, Jr. and James A. Proctor, III for SHOULDEREMBODIMENT OF PERIPROSTHETIC FRACTURE REPAIR”.

This application is also related to U.S. patent application Ser. No.15/893,911 filed on Feb. 12, 2018 by Daniel Nick Segina, James A.Proctor, Jr. and James A. Proctor, III for PERIPROSTHETIC FRACTUREMANAGEMENT ENHANCEMENTS, which is a continuation of U.S. patentapplication Ser. No. 15/372,609 filed Dec. 8, 2016, by Daniel NickSegina, James A. Proctor, Jr. and James A. Proctor, III forPERIPROSTHETIC FRACTURE MANAGEMENT ENHANCEMENTS, which is a continuationof U.S. patent application Ser. No. 15/068,923 filed on Mar. 14, 2016 byDaniel Nick Segina, James A. Proctor, Jr. and James A. Proctor, III forPERIPROSTHETIC FRACTURE MANAGEMENT ENHANCEMENTS, which is a continuationof U.S. patent application Ser. No. 14/200,678 filed on Mar. 7, 2014 byDaniel Nick Segina, James A. Proctor, Jr. and James A. Proctor, III forPERIPROSTHETIC FRACTURE MANAGEMENT ENHANCEMENTS, which is a continuationof U.S. patent application Ser. No. 13/398,512 filed on Feb. 16, 2012,by Daniel Nick Segina, James A. Proctor, Jr. and James A. Proctor, IIIfor PERIPROSTHETIC FRACTURE MANAGEMENT ENHANCEMENTS, which claims thebenefit of U.S. Provisional Application No. 61/443,292, filed on Feb.16, 2011.

The entire teachings of all of the above patent applications areincorporated herein by reference.

BACKGROUND 1. Field

The present disclosure relates generally to methods and apparatus forallowing for improvements in the repair of periprosthetic fractures. Insome embodiments, these improvements involve the inclusion of featureswithin the implanted prosthetic allowing for use of an apparatus foreffective and efficient alignment and installation of one or morefracture stabilization components and related components.

2. Related Art

The current state of fixation of periprosthetic fracture revolves arounddevices that are designed to avoid originally placed femoral, tibial,humeral, or other components. With a multitude of different fracturepatterns that could clinically exist, current solutions for thevariability of fracture patterns revolve around the use of either anexternal bone plate or an internal medullary rod/nail.

Existing approaches for conventional periprosthetic fracture managementoften result in sub-optimal prognosis as compared with fracturemanagement in the absence of a conventional prosthesis. Additionalimpacts to the patient recovery time result from significantly moreinvasive procedures being required for the application of suchconventional fracture management devices.

SUMMARY OF PREFERRED EMBODIMENTS

Embodiments of the current invention provide for pre-engineered fracturefixation contingent solutions into femoral, tibial, shoulder, humeral orother components, resulting in a distinct clinical advantage in theplanning and execution for periprosthetic fracture fixation. Additionalembodiments include a pre-engineered solution to intimately associatewith the previously placed total hip arthroplasty or total kneearthroplasty and further in some embodiments utilize approaches forallowing targeting of required fasteners, screws and the like, using amechanically associated relationship to the existing prosthetic, orother components.

Specific embodiments are related to the design of prosthetics forartificial hip and knee replacement, the repair of Periprostheticfractures, and associated methods and apparatus for use in theapplication of fracture stabilization components. Additional embodimentsprovide for a variety of fracture fixation options should a fractureoccur after total hip arthroplasty or total knee arthroplasty.

Other embodiments are more specific to standard or reverse totalshoulder replacement, the repair of fractures related to the same, andassociated methods and apparatus for use in the application of fracturestabilization components. Additional embodiments provide for a varietyof fracture fixation options should a fracture occur after such shoulderreplacement.

To support the application of such fixation options in specificembodiments provide for apparatus and methods to include the use ofalignment devices and other components to allow methods for ease ofrepair of Periprosthetic fractures utilizing the pre-engineeredsolutions. Such targeting devices are required in specific circumstancesas the prosthetics may prevent x-ray imaging and consequently free handalignment. Specific embodiments of the aforementioned alignmentdevice/outrigger may be composed of carbon fiber or other materialstransparent to imaging technology utilizing radio lucent materials.

In one embodiment, a method for repairing a periprosthetic fracturecomprises mounting an aligning device in mechanical registration with anin situ prosthetic component and locking a fracture stabilizationcomponent, and aiming arm, the aligning device and the in situprosthetic component in mechanical alignment, utilizing the aiming armto provide alignment of one or more mechanical cannula with one or moreprosthetic component interfaces and securing one or more bone fracturesegments associated with the periprosthetic fracture with said fracturestabilization component using screws, wherein the fracture stabilizationcomponent and the prosthetic component are further mechanically secured.

In another embodiment, a periprosthetic fracture device comprisesmounting an aligning device in mechanical registration with an in situprosthetic component and locking a fracture stabilization component, andaiming arm, the aligning device and the in situ prosthetic component inmechanical alignment, utilizing the aiming arm to provide alignment ofone or more mechanical cannula with one or more prosthetic componentinterfaces and securing one or more bone fracture segments associatedwith the periprosthetic fracture with said fracture stabilizationcomponent using screws, wherein the fracture stabilization component andthe prosthetic component are further mechanically secured.

In another embodiment, the prosthetic component further comprises athreaded coupling point for receiving the aligning device.

In another embodiment, the prosthetic component further comprises aguide wire.

In another embodiment, the aligning device and the aiming arm are asingle component.

In another embodiment, the prosthetic component is a modified femoralcomponent, and wherein said femoral component interfaces with aperiprosthetic distal femoral polyaxial locking plate.

In another embodiment, the prosthetic component is a modified tibialtray component.

In still other arrangements, the component interface may be notched orkeyed for proper rotational alignment.

In another embodiment, the mechanical registration is a notchedmechanical interface between a femoral nail and the prostheticcomponent.

In another embodiment, the aligning device and the aiming arm aremechanically assembled components.

In another embodiment, the fracture stabilization component comprisesone of the following: a femoral nail, tibial nail, femoral plate, ortibial nail.

Still other embodiments are specific to a standard or modified totalshoulder arthroplasty. Accommodating periprosthetic fractures around theshoulder presents a different challenge than the knee or other joints.The size of the medullary canal in conjunction with the distal humeralanatomy as well as proximal fill of the arthroplasty component limitfracture fixation options in the event of a periprosthetic fracture.

In one embodiment for a shoulder implementation, a medullary fixationdevice includes a registration component that aligns with a humeralcomponent sheath. The medullary fixation device may accommodateinsertion of fracture stabilization devices in the future. Lockinghardware allows for length and rotational control.

The humeral sheath may include an outer portion having an optionalinterface to a vacated inner core, permitting a fixation device toextend beyond a distal extent of the humeral bone fracture.

In some embodiments, the sheath may be integrated with the prosthesis,or a separate component that is inserted into the prosthesis and securedvia a threaded channel.

As with other embodiments, an aiming arm can assist with rotationalcontrol as well as distal alignment for the targeting and insertion ofinterlocking devices.

In embodiments for reverse total shoulder arthroplasty, anextra-medullary fixation device may be used. The extra-medullary deviceincludes an outrigger/aiming arm to interface with an intact humeralstem component. The extra-medullary fixation device may include a platewith optional aiming cannula and interlocking devices.

In some embodiments, the interlocking devices may be screws that passthrough the extra-medullary plate and the underlying bone, to thehumeral stem component including the outer sheath and inner core.

Optionally, an aiming arm containing an aiming cannula may provide forregistration and alignment allowing for the passage of an interlockingdevice, such as a screw, through the outer bone cortex, through a distalaspect of a medullary fixation device, to the innermost cortex of thedistal humeral bone.

In an embodiment, a proximal locking cap may be placed to providecoverage over the extra-medullary fixation device and the underlyinghumeral stem component screws. The proximal locking cap may also allowfor alignment and rotational registration between the intact humeralstem and the medullary fixation device.

An alternative standard total shoulder embodiment may contain a humeralhead articular component as well as solid shaft component or humeralstem component that includes an interface for coupling an extramedullaryaiming arm.

A locking end cap containing a recess for a tool such as a hexscrewdriver may be used, such an end cap may have a threaded tipallowing for interfacing with a solid humeral core component. Both therecess and the outer diameter of the locking end cap may be circular,thus allowing for unencumbered rotation.

In another embodiment, the interface between the humeral component solidcore and the surrounding humeral component may include registrationslots or notches brought into alignment with the use of the registrationwashers or other hardware, and may have features that accommodate theuse of tools for securing the hardware. This arrangement providesfurther solid axial and rotational control.

BRIEF DESCRIPTION OF THE DRAWINGS

The foregoing will be apparent from the following more particulardescription of example embodiments, as illustrated in the accompanyingdrawings in which like reference characters refer to the same partsthroughout the different views. The drawings are not necessarily toscale, emphasis instead being placed upon illustrating the configurationand use of the different embodiments.

FIG. 1 is an illustration of a first defined fracture below the hipprosthesis.

FIG. 2 is an illustration of an embodiment including: Modified FemoralComponent to Accommodate Cannulated Outrigger, Custom Modular Plate andTargeting Device.

FIG. 3 is an illustration of an embodiment including: AlternativeModified Femoral Component to Accommodate Cannulated Outrigger, CustomRetrograde Nail and Targeting Device.

FIG. 4 is an illustration of an embodiment including: Magnified detailof Modified Femoral Component Tip to Accommodate Retrograde Nail.

FIG. 5 is an illustration of a periprosthetic distal femur fracture.

FIG. 6 is an illustration of an embodiment including: Angular StableRetrograde Periprosthetic Distal Femoral Nail.

FIG. 7 is an illustration of an embodiment including: Detailed LateralProjection of Modified Femoral Component (601).

FIG. 8 is an illustration of an embodiment including: Detail of (703)Angular Stable Set Assembly with Free Rotating Angular Interface.

FIG. 9 is an illustration of an embodiment including: Distal AxialProjection of FIG. 6 : Angular Stable Retrograde Periprosthetic DistalFemoral Nail.

FIG. 10 is an illustration of an embodiment including: Distal FemoralPeriprosthetic Plate Fixation with contingent prosthetic interface.

FIG. 11 is an illustration of an embodiment including: LateralProjection of Distal Femoral Periprosthetic Plate Fixation withcontingent prosthetic interface.

FIG. 12 is an illustration including a fracture below the tibial tray.

FIG. 13 is an illustration of an embodiment including: Modified TibialTray to accommodate contingent fracture management.

FIG. 14 is an illustration of an embodiment including: LateralProjection of (FIG. 13 ) Modified Tibial Tray to accommodate contingentfracture management.

FIG. 15 is an illustration of an embodiment including: 2D rendition of(1203) Prosthetic Tibial Tray.

FIG. 16 is an illustration of an embodiment of Contingent ProstheticTibial tray accommodation for Proximal Tibial Locking Plate formanagement of Periprosthetic fracture management.

FIG. 17 is an illustration of a Lateral Rendition of (FIG. 16 ) anembodiment of Contingent Prosthetic Tibial tray accommodation forProximal Tibial Locking Plate for management of Periprosthetic fracturemanagement.

FIG. 18 is an illustration of an embodiment of Tibial ContingentAccommodation and Mounting of Tibial Plate.

FIG. 19 is a reference diagram of a human anterior shoulder showing thehumerus and glenoid cavity.

FIG. 20 is a more detailed view of a notched cap used with prosthetichaving a core.

FIG. 21 is a more detailed view of a native shoulder.

FIG. 22 illustrates a shoulder prosthetic for total arthroplasty withouta hollow core component.

FIG. 23A shows a modified total shoulder arthroplasty with a prosthetichaving an integrated solid core surrounded by an outer sheath.

FIG. 23B contains an overall representation of a reverse total shoulderarthroplasty in an alternative embodiment.

FIG. 24 shows partial disassembly of a cap and core of the prosthesis.

FIG. 25 is a further view of the disassembled core and cap.

FIG. 26 is a view of a disassembled alignment arm and broken bone.

FIG. 27 illustrates the assembled alignment arm.

FIG. 28 shows an arm with the cannula for aligning fasteners to thesheath and a longer quote fracture fixation component

FIG. 29 is an assembled view.

FIG. 30 illustrates screws inserted into clearance holes.

FIG. 31 another view of the assembly of the targeting arm andprosthesis.

FIG. 32 is another view of the assembly.

FIG. 33A is a modified total shoulder arthroplasty now showing aprosthetic fracture fixation component.

FIG. 33B shows a modified reverse total shoulder arthroplasty with theperiprosthetic fracture fixation component having integrated core andouter sheath.

FIG. 34 shows a modified reverse total shoulder arthroplasty withfracture fixation and a registration outrigger plate.

FIG. 35A shows the assembly with screws attached.

FIG. 35B shows a similar view but with a different joint structure.

FIG. 35C is yet another embodiment showing fixation fracture fixationwith the registered outrigger plate.

FIG. 35D shows a modified reverse total shoulder arthro plasty with theregistered outrigger plate but without a removable core.

FIG. 36 shows disassembled components of a modified prosthesis.

FIGS. 37A, 37B and 37C illustrate a recessed end interface, registrationwasher and cap.

FIGS. 38A and 38 B illustrate sequential assembly of an interface.

FIGS. 39A and 39B also illustrate further sequential assembly in cutawayand superior views.

FIG. 40A a cutaway view of recessed locking interface cutaway.

FIG. 40B is superior view for FIG. 40A.

FIG. 41 illustrates attachment of an aiming arm for registration.

FIG. 42 illustrates assembly of the aiming arm with intact humoralcomponent.

FIG. 43 illustrates another implementation of the outer aiming arm andhumeral components.

FIGS. 44A and 44B show a telescopic hex fixation tool.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

A description of example embodiments follows.

FIG. 1 : Problem #1—Fracture Below Hip Prosthesis

FIG. 1 shows an existing problem in the industry of a fracture below ahip prosthesis. The prosthesis 101, articulates with the hip joint 104,as is known within the industry. Furthermore, the Hip Prosthesis 101 isimplanted within the proximal femur 102. Periprosthetic Femur fracture103 occurs post implantation of the prosthesis 101, into the proximalfemur. The current challenge within orthopedic surgery is the fixationof a fracture after implantation of Hip Prosthesis 101. The metallicimplant obscures the capacity to provide for fixation through the boneby occupying the inner space of the medullary femoral canal. Clinicalsolutions attempt to avoid the femoral prosthesis 101 by providing forscrew trajectories away from the implant or options for circumferentialwire fixation around the implant. While the current fracture pattern 103is described within, this does not and is not intended to limit thescope of the application of the embodiments of this invention.

FIG. 2 : Embodiment of Solution #1—Modified Femoral Component toAccommodate Cannulated Outrigger, Custom Modular Plate and TargetingDevice.

This section discusses one embodiment to address the problem of FIG. 1 ,depicted in fracture pattern 103.

Modified Femoral Component 201 is implanted into the proximal femur.

Femoral component 201 with hollow core 212 to accommodate guide aTargeting Guide Wire 202 is depicted to provide for a reference pointfor an aligning device, such as Cannulated Outrigger 203. This allowsfor alignment and an intimate association between Femoral Component 201and an aligning device, such as Cannulated Outrigger 203, resulting in aunique interface reference point 211. Interface Reference point 211 mayutilize keyed interfaces between an aligning device, such as CannulatedOutrigger 203 and between Femoral Component 201 so as to allow for afurther angular or rotational reference. As a result, spatialorientation is now predetermined and referenced off of the previouslyimplanted Femoral Component 201. With a fracture stabilizationcomponent, such as the Cannulated Outrigger 203 mated to ModifiedFemoral Component 201, an aiming arm, such as a Distal Targeting Device205 can then be assembled to provide for appropriate and accuratetargeting of Fixed Angled Locking Screws 206; targeting through ScrewAlignment Cannulae 207 thus providing a mechanism for security fixationof a fracture stabilization component, such as the Custom Modular Plate204A, 204B, and 204C. Clinical solutions for Coupling Point 208represent a mating mechanism between the Cannulated Outrigger 203 and anaiming arm, such as the Distal Targeting Device 205. This intimate fit,once again, assures appropriate targeting of the Fixed Angled LockingScrews 206 through the Modified Femoral Component 201 which revolvesaround fixation. The Modified Femoral Component 201 is implanted intothe Native Femur depicted as 209. The interface between Modified FemoralComponent 201 and Cannulated Outrigger 203 is described via a threadedCannulated Outrigger Interface 211. The cannulation of this interfacehappens over a hollow core 212 which is inserted through CannulatedOutrigger 203 and the Modified Femoral Component 201.

The capacity for the Modified Femoral Outrigger 203 to be mated to theFemoral Component 201 provides for accurate reference point to thustarget the screws depicted in 206. This overcomes the challenge ofalignment, which is not referenced, and presents a difficult clinicalchallenge for targeting the appropriate screw 206 and implant 201interfaces. The clinical benefits extend to the decreased surgical timedue to known reference point between Modified Femoral Component 201 and203; in addition to decreased surgical trauma and surgical dissection inattempts to find the appropriate alignment between Modified FemoralComponent 201, Plate 204A, B, and C, and Screw 206. The capacity tolimit surgical time as well as surgical exposure necessarily translatesinto decreased cost as well as decreased patient morbidity.Additionally, improved mechanical fixation would be enhanced due toaccurate targeting and interface between Modified Femoral Component 201and a fracture stabilization component, such as Modular Plate 204A, B,and C as well as Screws 206. Femoral Component 201 would be inserted atthe time the patient would be undergoing a total hip arthroplasty. Theutility of the interface 211 would come into play after a periprostheticfracture was to occur. The insertion of Guide Wire 202 into ModifiedFemoral Component 201 to facilitate the interface of CannulatedOutrigger 203 would be temporary. This interface can then be uncoupledafter fixation of the fracture has occurred through the use of afracture stabilization component, such as the Modular Plate 204A, B, andC and screw fixation with Screw 206. The pre-engineered geometry inModified Femoral Component 201 would be done at the time of manufactureof said component. Additionally, the Interface 211 as well as the screwholes for Screw 206 would be incorporated into Component 201 prior toimplantation, thus ready to be utilized at a future date shouldperiprosthetic fracture of Native Femur 209 occur after total hiparthroplasty. Necessitates it is inserted into the Modified FemoralComponent 201 and around the prosthesis either via screws in atrajectory that does not interfere with the Prosthesis 101 or wires thatwrap around the bone properly, providing for a method of fixation thatonce again does not interfere with Prosthesis 101. It should be notedthat this deals with only one specific fracture pattern of the proximalfemur below a Hip Prosthesis 101. Other potential fracture patterns doexist around other prosthetic implants which will be addressed infurther figures in this document.

FIG. 3 : Solution #2—Alternative Modified Femoral Component toAccommodate Cannulated Outrigger, Custom Retrograde Nail and TargetingDevice

FIG. 3 represents an alternative embodiment of the modified femoralcomponent 301 and associated components. This embodiment of the modifiedfemoral component accommodates a custom retrograde Femoral Nail 304 inthe treatment of a periprosthetic distal femur fracture. The modifiedFemoral Component 301 would be inserted at the time of total hiparthroplasty; this component is utilized as a component of fixation ofsaid fracture of the Native Femur 309 after total hip arthroplasty. TheGuide Wire 302 is inserted through the Modified Femoral Component 301which contains an inner cannulation component. The guide wire isadvanced to the end of the Native Femur 309 and goes past the fracturesite. This guide wire is then be utilized to direct the CustomRetrograde Femoral Nail 304 so that it is placed over the tip of theModified Femoral Component 301 to provide for an engagement andsubsequently secure fracture fixation. The interface between theModified Femoral Component 301 and the Custom Retrograde Femoral Nail304 will be further depicted in FIG. 4 which is labeled in the currentdiagram as 311. Some embodiments will provide for a keyed interface 311between the Modified Femoral Component 301 and the Custom RetrogradeNail 304. The insertion of the Guide Wire 302 to accommodate and guidethe Retrograde Femoral Nail 304 takes place at the time of surgicalrepair of the fracture. Once the guide wire has been passed to the endof the Native Femur 309 an opening at the distal femur would occur toprovide for an entry portal of the Retrograde Femoral Nail 304. Attachedto the Retrograde Femoral Nail 304 would be an aligning device, such asthe custom Cannulated Outrigger 303. This outrigger is cannulated toaccommodate the Guide Wire 302 and the Guide Nail 304 to the appropriateposition at the tip of the Customized Modified Femoral Component 301.Attached to 303 will be an aiming arm, such as the Proximal TargetingDevice 305. The adjoinment of 305 to 303 would occur at Coupling Point308. Once an aiming arm, such as the proximal targeting device, is inplace it would provide for appropriate and predetermined targeting forthe Fixed-Angled Interlocking Screws 306 both at the proximal and distalaspect of the fixation. The screws would align with the fixation device,customized Retrograde Femoral Nail 304, with the use of an aiming arm,such as the proximal targeting device, and the Screw Alignment Cannula307. A cutaway diagram reveals a three-dimensional profile of an aimingarm, such as Proximal Targeting Device 305, which is labeled 312 in thisfigure. The benefits of this embodiment provide for a biologicallyfavorable method of fixation that is amenable to minimal soft tissuestripping thus preserving biology around the fracture and helpingpromote rapid healing. Additionally, surgical time would besignificantly shortened. Biomechanical favorability is also achievedwith the overlap interface that is obtained between the CustomizedModified Femoral Component 301 and the Custom Retrograde Femoral Nail304. Once again this interface, labeled 311, will be further depicted inthe next drawing.

In addition, Modified Femoral Component distal tip 311, may include (inspecific embodiments) a specific alignment key feature which allows foralignment of pre-drilled holes which may be present in the CustomRetrograde Femoral Nail 304, and the Modified Femoral Component 301,such that a keying feature angularly aligns with a keying featurepresent in the Retrograde Femoral Nail 304. One such keying feature maybe a notched interface, allowing for proper rotational alignment.

FIG. 4 : Magnified Detail of Modified Femoral Component Tip toAccommodate Retrograde Nail

In FIG. 4 the depiction represents the interface on a magnified scalebetween the Modified Femoral Component 301 and the Custom RetrogradeFemoral Nail 304. The interface is further specified as 311. In thisdepiction, a tapering and smaller diameter at the tip of 301 is designedto provide for a unique and overlapping interface between the ModifiedFemoral Component 301 and the Retrograde Femoral Nail 304. This overlaphelps achieve mechanical stability by preventing a stress riser thatwould occur if no overlap were to exist. Additionally, a predeterminedtrajectory would be placed and aligned to accommodate the Angular StableInterlocking Screw 306. This would interface through the cortical bonedepicted as 401 as well as the Custom Retrograde Femoral Nail 304 andthe Modified Femoral Component 301 and subsequent Modified FemoralComponent Distal Tip 311. The ability to target this screw and align itappropriately would be facilitated through the attachment of an aligningdevice, such as the Cannulated Outrigger 303 depicted in FIG. 3 alongwith an aiming arm, such as the Proximal Targeting Device 305 andsubsequent Alignment Cannula 307.

FIG. 5 : Problem #2—Periprosthetic Distal Femur Fracture Above aProsthetic Total Knee Arthroplasty.

Depicted in FIG. 5 is the clinical scenario where a fracture would occurabove a previously inserted total knee arthroplasty. The fracture wouldoccur in the Native Bone 504 and be depicted by the Fracture Pattern501. Please note that this is one of potentially many different fracturepatterns that may exist and this is only one embodiment of this saidfracture. The Femoral Component 502 would be placed onto the NativeFemur 504 at the time of total knee arthroplasty. Similarly, the TibialComponent 305 would be placed into the Native Tibia 505 at the time oftotal knee arthroplasty to articulate the Femoral Component 502.Additionally depicted is the Native Fibula 506. The clinical problemthat will be subsequently discussed will be to address said fracture 501above a total knee arthroplasty otherwise known as a periprostheticdistal femur fracture.

FIG. 6 : Embodiment of Solution #3—Angular Stable RetrogradePeriprosthetic Distal Femoral Nail

In an embodiment of one of the current inventions, the alignment devicesincluding the Cannulated Outrigger 603, Proximal Targeting Device 605,Angular Stable Screw Alignment Cannula 606, and Couple Point 604 can beconstructed out of a radiolucent material to provide for an avenue ofX-ray visualization to help assure appropriate alignment as well asplacement. In this embodiment, alignment device required as theprosthetics prevent x-ray imaging and free hand alignment. This is a keyadvantage and solution to an existing problem. Also note that thealignment device/outrigger may be composed on carbon fiber or othermaterials transparent to imaging technology using radio lucent materialsin some embodiments.

FIG. 7 : Detailed Lateral Projection of an Embodiment of a ModifiedFemoral Component (601)

Depicted in this drawing is a lateral projection of an embodiment of theModified Femoral Component 601 with the Custom Angular Stable RetrogradeFemoral Nail 602 being inserted as would happen in a clinical scenarioduring fracture repair. The insertion is to the point where theinterface is occurring between the Modified Femoral Component 601 andthe Custom Retrograde Angular Stable Femoral Nail 602. The alignment aswell as insertion would be facilitated over Guide Wire 610 and throughthe attached Custom Outrigger 603, aiming arm, such as ProximalTargeting Device 605, Alignment Cannula 606, and Coupling Point 604.Depicted out of plane is the Angular Stable Interlocking Screw 607 whichwould traverse the region labeled 702 and interact with the modificationof Modified Femoral Component 601, depicted as 701. The interface andalignment is secured between the Custom Retrograde Femoral Nail 602 andan aligning device, such as the Cannulated Outrigger 603 by a ThreadedInterface 608. The design of Subcomponent 601, that is labeled 701,would be made in a way to accept the Retrograde Femoral Nail 602 as wellas provide for the traversing of the Angular Stable Interlocking Screw607. The geometry is designed, as such, to control the coronal andsagittal plane angulatory forces to help maintain alignment. The finalcapacity to be able to maintain this alignment would be facilitated bythe angular stable set assembly end cap with three rotating angularinterfaces. Further detail of this object will be described in FIG. 8 .Further details around the Area 701, which is specifically described ascontingent prosthetic distal femoral nail interface, will be provided.The design of 701 would be manufactured into the Component 601 at thetime of initial manufacturing. This modification, 701, would exist atthe time of total knee arthroplasty and be present as a contingentsource of fixation with angular stabilization should a fracture of thedistal femur arise. The geometry of 701, once again, would be to acceptthe Angular Stable Interlocking Screw 607 as well as the angular stableset assembly end cap with Free Rotating Angular Interface 703. Theaddition of these two devices through the portal labeled 702 would thenbe able to obtain and maintain sagittal as well as coronal planestability. This embodiment encompasses the distinctive benefits of both703 by itself, and 701 by itself, as well as combined. Further use of701 as a contingent structure, and separately as a device to accept thenail in operation are further contemplated.

FIG. 8 : Detail of an Embodiment of (703) Angular Stable Set Assemblywith Free Rotating Angular Interface

Depicted in FIG. 8 is a breakdown of an embodiment of the components ofthe angular stable set assembly end cap with free rotating angularinterface. This end cap would be inserted through the Custom Outrigger603 over the Guide Wire 610. It would then interface through thesubcomponent of the Modified Femoral Component 601, labeled as 701. Thisinterface would then provide for a frictional fit to secure the AngularStable Interlocking Screw 607. Depicted in FIG. 8 is 703A which is theangular portion of the angular state assembly end cap. This is depictedas having a smooth surface to provide for a free-glide insertion withoutinterfacing with underlying threads. Allowing for the insertion would bea Threaded Component 703B. This would interface the threaded componentof the Custom Retrograde Femoral Nail 602 at the region labeled 608 inFIG. 7 . The threaded capability of this component provides for athreaded and locked frictional fit to secure the interface betweenSubcomponent 703 of the angular stable set assembly with free rotatingangular interface and the Angular Stable Interlocking Screw 607. Freerotation of this device would be allowed through the interfacecontaining a smaller diameter to engage, labeled 703C. The entireAssembly 703A, 703B, and 703C, once placed over the Guide Wire 610,would be screwed into position using the Cannulated Screwdriver 801.

FIG. 9 —Distal Axial Projection of FIG. 6 and an Embodiment of anAngular Stable Retrograde Periprosthetic Distal Femoral Nail

Depicted in FIG. 9 is an embodiment of the current invention includingan axial projection viewing the inner-connular region of the ModifiedFemoral Component 601. Once the Retrograde Femoral Nail 602 is insertedthrough the inner-connular notch over Guide Wire 601, and facilitated byan aligning device, such as the Cannulated Outrigger 603, an AngularStable Interlocking Screw 607 would then be inserted. This insertionwould be introduced with the Alignment Cannula 606 and placed through anaiming arm, such as the Proximal Targeting Device 605. The interfacewould occur at the modified subcomponent of Modified Femoral Component601, labeled 703. The projection of 703 in this diagram is a combinationof 701 and 702 from FIG. 7 . The purpose of this depiction is todemonstrate that no alteration of the surface of the Modified FemoralComponent 601 would occur at the time that the fracture fixation wouldtake place, using the insertion of Modified Retrograde Femoral Nail 602and the placement of Angular Stable Interlocking Screw 607.

FIG. 10 : Solution #4—Distal Femoral Periprosthetic Plate Fixation withContingent Prosthetic Interface

Depicted in this diagram is an alternative embodiment of a method offixation to deal with a periprosthetic distal femoral fracture. Thisfracture would be of Native Bone 504 and is depicted as Fracture Pattern501. The Modified Femoral Component 1001 would be placed at the time oftotal knee arthroplasty. Modifications would be in place at the time ofmanufacture of Modified Femoral Component 1001 and be available for acontingent fracture fixation should Fracture 501 occur after total kneearthroplasty takes place. The Modified Femoral Component 1001 is furtherdescribed as a modified femoral component that interfaces with customangle stable periprosthetic distal femoral, polyaxial locking plate. InFIG. 10 , the Distal Plate Outrigger 1003 is shown to connect to theCustom Angular Stable Periprosthetic Distal Femoral Polyaxial LockingPlate 1004 through the 1003/1001 custom interface—prosthetic contingentmounting interface. Through Couple Point 1008 Proximal Targeting Device1005 is depicted providing for cannula placement for Screw AlignmentCannula 1007. Through 1007 there would be placed some Fixed AngledLocking Screws 1006 which would interface and subsequently thread intoPlate 1004. Distally, once 1009 prosthetic contingent mounting interfaceis installed to 1004 as well as 1001, the predetermined alignment wouldbe allowed for the placement of Central Distal Angular StableInterlocking Screw 1011 through the Central Distal Angular Stable ScrewPortal 1010.

This alternative embodiment of fixation for Distal Femoral Fracture 501utilizes a plate-and-screw construct to achieve axial, sagittal, as wellas coronal plane alignment maintenance. The capacity to interface withModified Femoral Component 101 allows for no reliance upon the integrityof the Distal Femoral Bone 504, but rather the ability to directlyinterface and adjoin to Modified Femoral Component 101 so as to maintainabove-said alignments in all three planes. Fracture fixation andalignment is also further maintained with the insertion of additionalLocking Screws 1006 above and below the Periprosthetic Fracture 501. Theclinical advantage of this device once again provides for minimallyinvasive exposure of the distal femur and soft tissue preservation forenhanced biologic preservation around Fracture Site 501. Aiming arm,such as the Proximal Targeting Device 1055 would reside outside the skinof the soft tissue envelope of the Femur 504 and guide 1007, screwalignment cannula, through the skin to align appropriately with theCustom Angular Stable Periprosthetic Distal Femoral Polyaxial LockingPlate 1004. Screws would then be inserted through the Plate 1004 andUnderlying Bone 504 and lock into position.

FIG. 11 : Lateral Projection of an Embodiment of a Distal FemoralPeriprosthetic Plate Fixation with Contingent Prosthetic Interface

This figure details an embodiment of the three-phase interface betweenModified Femoral Component 1001, the custom angular stableperiprosthetic distal femoral plate and the Distal Femoral Outrigger1003. Depicted in 1009 is the interface that allows for the adjoining of1003 to Modified Femoral Component 1001 as well as the Interposed Plate1004. The ability to interface all three components provides for theability to specifically target an angular stable interlocking screwdepicted as 1011 in FIG. 10 . With the adjoining of these components afixed-angled construct would exist between the Modified FemoralComponent 1001 and the Custom Angular Stable Plate 1004; thus being ableto achieve the maintenance of axial, sagittal, as well as coronal planealignment and avoid the reliance upon underlying native bone quality.Additionally depicted is a Central Pole 1010 that would accommodate alarge central angular stable interlocking screw for additional fixation.This screw may be placed in a polyaxial locking capacity. Of note, isthe modifications of the Distal Femoral Component 1001 to accommodatethe adjoining interface to Custom Angular Stable Locking Plate 1004 andthe modifications to Modified Femoral Component 601 to accommodate theCustom Retrograde Femoral Nail 602 can be made within the same implant.With both options available for either plate or nail fixation, a varietyof different fixation strategies can be accommodated by the sameModified Femoral Component. Once again, these modifications would takeplace at the time of manufacture of the Modified Femoral Component601/1001 and not interfere with the articulation of the planned totalknee arthroplasty. The contingencies would remain in place and providefor fixation options should a distal femoral fracture depicted as 501,occur.

1009 allows for the joining of the 1003 outrigger to 1004 plate, andadditionally provides for the joining of 1001 femoral component to 1004plate.

In one embodiment, a screw is used to mount the outrigger, through theplate's holes top the prosthetic. 1009 allows for the joining of the1003 outrigger to 1004 plate, and additionally provides for the joiningof 1001 femoral component to 1004 plate. In one embodiment screws areused to mount the outrigger, through the plate's holes on top of theprosthetic. In this embodiment, several novelties in the prostheticinclude contingent accommodations for femoral fracture managementprocedures, and further the specifics of those accommodations and theiruse at the time of the repair, and the details of the attached devicesand methods for using the features provided.

FIG. 12 : Problem #3—Fracture Below Tibial Tray

Depicted in FIG. 12 is the Native Tibia 1201 as well as potential futurefracture of the proximal tibia, labeled 1202. Please note that theFracture Pattern 1202 is only one potential fracture pattern that couldexist below the tibial tray component of the total knee arthroplasty.The tibial tray component is labeled in this diagram as 1203.

FIG. 13 : Solution #5—Modified Tibial Tray to Accommodate ContingentFracture Management

Depicted in FIG. 13 is one embodiment of the fracture management deviceto address fracture of a Tibial Component 1203 with the fracturedepicted as 1202. A Guide Wire 1301 would be inserted at the time offracture fixation through the Tibial Component 1203 through theInterface 1307. Over this guide wire would be placed a Tibial NailFixation Device 1309 with the insertion of 1309 being facilitatedthrough an aligning device, such as a Cannulated Outrigger 1302 andaiming arm, such as Proximal Targeting Device 1303. Further details of acoupling point between 1302 and 1303 are depicted as 1304. Providing forappropriate targeting and placement of the Fixed-Angled Locking Screw106 would be the Screw Alignment Cannula 1305 inserted through theProximal Targeting Device 1303. The advantage of this design providesfor medullary fixation of the fracture of the Native Tibia 1201 with thefracture pattern depicted as 1202. The ability to have the ContingentProsthetic Accommodation Portal 1307 be in place prior to the fractureprovides a significant clinical advantage for potential fracturefixation. The biomechanical and biological advantages of medullaryfixation for a fracture pattern depicted as 1202 of the Native TibiaBone 1201 are extensive. Ease of operation, maintenance of the currenttotal knee arthroplasty, as well as preservation of biology are alldistinct advantages. The addition of biomechanical favorability with themedullary implant is also noted.

FIG. 14 Lateral Projection of (FIG. 13 ) Modified Tibial Tray toAccommodate Contingent Fracture Management

FIG. 14 represents a Lateral Projection of (FIG. 13 ) an embodiment ofModified Tibial Tray to accommodate contingent fracture management.Through this lateral projection the Modified Tibial Nail 1309 isinserted through the Customized Tibial Prosthetic Tray 1203 through theInterface 1307. The nail is inserted over a Guide Wire 1301 with thisinsertion facilitated by an aligning device, such as the CannulatedOutrigger 1302 as well as Proximal Targeting Device 1303. Byinterlocking the screw 1306 alignment is assured through the AlignmentCannula 1305, with Interlocking Screw 1303 being placed utilizing thismechanism. To secure fixation between the Tibial Nail 1309 and theTibial Tray 1203 with this Contingent Prosthetic Accommodation Interface1307 is a Cannulated Coupling Interface 1308. This interface wouldprovide for fixation between 1309 and 1203. As with the previousdevices, the modification to the Tibial Tray 1203 would occur at thetime of manufacture and be present as a contingent fixation optionshould a fracture of Native Tibia Bone 1201 occur in a fracture patterndepicted as 1202.

FIG. 15 2D Rendition of (1203) Embodiment of a Prosthetic Tibial Tray

FIG. 15 represents a three-dimensional projection of an embodiment ofthe Prosthetic Tibial Tray 1203 with the Contingent ProstheticAccommodation Portal 1307. Of note there is no modification to thearticulating surface of 1203 depicted as 1501.

FIG. 16 —Embodiment of Contingent Prosthetic Tibial Tray Accommodationfor Proximal Tibial Locking Plate for Management of PeriprostheticFracture Management

Depicted in FIG. 16 is an alternative embodiment of fixation forfracture of the Native Bone 1201, depicted as Fracture Pattern 1202. Theplacement of the Tibial Tray 1201 would take place at the time of totalknee arthroplasty. Fracture below the tibial tray, depicted as 1202,would occur and fixation of said fracture would be managed through themodification of the Tibial Tray 1201. The modifications in Tibial Tray1201 are made to provide for the adjoining of Custom Outrigger 1602 thatwould thread into the Modified Tibial Tray 1601 at the ProstheticContingent Mounting Interface 1608. This would be through the platelabeled 1604. All three components, 1602, 1604, and 1601 would thus beintimately joined together to provide for appropriate targeting andfixation of Screws 1606. Attached to Proximal Plate Outrigger 1602 wouldbe an aiming arm, such as Distal Targeting Device 1603 that adjoins 1602through Coupling Point 1607. Through the Distal Targeting Device 1603Alignment Cannulae 1605 are placed to align the trajectory of theInterlocking Screws 1606.

A distinct clinical advantage for the capacity to align and subsequentlymaintain the interface between the Tibial Fixation Plate 1604 and theModified Tibial Tray 1601 relates to the capacity to maintain axial,sagittal, as well as coronal plane alignment both above and belowfracture of the Native Tibia 1201, depicted as Fracture Pattern 1202.The plate is designed to be placed in a minimally invasive fashion toavoid compromise of the biology around Fracture 1202. Further clinicaladvantage is noted by the decrease in surgical time with predeterminedtargeting as well as enhanced biomechanical properties with the intimateassociation between the Tibial Plate 1604 and Modified Tibial Tray 1601.

FIG. 17 : Lateral Rendition of (FIG. 16 ) an Embodiment of ContingentProsthetic Tibial Tray Accommodation for Proximal Tibial Locking Platefor Management of Periprosthetic Fracture Management

A lateral projection depicted in FIG. 17 reveals further detail as tothe interface between the Underlying Modified Tibial Tray 1601, TibialFixation Plate 1604, as well as the Proximal Plate Outrigger 1602 andaiming arm, such as Proximal Targeting Device 1603. This interfaceallows adjoinment of the tibial fixation plate directly to the ModifiedTibial Tray 1601 at the Interface 1608. This adjoinment is facilitatedthrough the placement of Angular Stable Interlocking Screws 1606. Theplacement being targeted through the Proximal Plate Outrigger 1602 aswell as aiming arm, such as Proximal Targeting Device 1603 and cannulae1605. With the intimate association between Tibial Tray 1601 and TibialFixation Plate 1604, the maintenance of axial, sagittal, as well ascoronal alignment is assured.

FIG. 18 : Detail of an Embodiment of Tibial Contingent Accommodation andMounting of Tibial Plate

In FIG. 18 a three-dimensional depiction of an embodiment of the tibialplate fixation device is noted. The Modified Tibial Tray Component 1601would interface with Tibial Fixation Plate 1604 through the regiondepicted as 1608. Tibial Tray Contingent Plate Accommodation MountingHoles 1801 would be present at the time of manufacture. The Tibial TrayComponent 1601 would be placed at the time of total knee arthroplasty.Contingent Mounting Holes 1801 would be in place and available to beutilized for fracture fixation should the need arise. These mountingholes would accommodate the Angular Stable Locking Screw 1606 placed toprovide for an interface and secure adjoining of Tibial Fixation Plate1604 to Tibial Tray Component 1601 through Mounting Holes 1801. Thismounting interface further assures the maintenance of axial, sagittal,as well as coronal plane alignment. The Tibial Tray Contingent PlateAccommodation Mounting Holes are labeled 1801.

The above-described embodiments of devices provide for a variety offracture fixation options should a fracture occur after total hiparthroplasty or total knee arthroplasty. The current state of fixationof above-said fracture revolves around devices that are designed toavoid originally placed femoral or tibial components. The ability topre-engineer fracture fixation contingent solutions into femoral ortibial components provides for a distinct clinical advantage in theplanning and execution for periprosthetic fracture fixation. With amultitude of different fracture patterns that could clinically exist,current solutions for the variability of fracture patterns revolvearound the use of either an external bone plate or an internal medullaryrod/nail. None of the devices that currently exist have a pre-engineeredsolution to intimately associate with the previously placed total hiparthroplasty or total knee arthroplasty. The Proximal Tibial PlateContingent Mounting Holes 1801 would be in place and present at the timeof manufacture. The Tibia fixation plate and further the Tibial TrayModification 1307 Entry Portal 13 below said component. This componentbeing labeled the further construct ability the depiction of the in theFIG. 8 as well as 503 would be inserted at the time a total kneearthroplasty would be performed.

FIG. 19 is a reference diagram of a human anterior shoulder. Ofparticular interest to the present discussion is the humerus and glenoidcavity.

FIG. 20 is a more detailed view of a notched cap used with prosthetichaving a core, to be described in more detail below.

FIG. 21 illustrates an intact proximal humeral shaft (designated withnumeral 21-10). The intact scapular body 21-20 includes intact articularsurface of the proximal humerus identified at 21-30. The intactarticular surface of the glenoid is identified as 21-40.

FIG. 22 is an overall depiction of a standard total shoulderarthroplasty with replacement of the proximal humerus as well as theglenoid. Specifics for the proximal humeral implant including the intactproximal humeral shaft 21-10 interfacing with humeral head arthroplastycomponent 22-10. The glenoid backing component is designated 22-20. Thearthroplasty/articular interface 22-30 represents the humeral componentof the articular interface. The glenoid of the articular interface isdesignated by 22-40. The arthroplasty component medullary stem isdesignated 22-50. This standard arthroplasty embodiment contains nocontingent features in the event of a periprosthetic fracture.Contrasted to periprosthetic fractures around the hip and knee,periprosthetic fractures around a total shoulder arthroplasty representa unique clinical challenge. The size of the medullary canal inconjunction with the distal humeral anatomy as well as proximal fill ofthe arthroplasty component limit greatly fracture fixation options inthe event of a periprosthetic fracture.

The overall depiction of FIG. 23A represents a modified standard totalshoulder arthroplasty with one embodiment detailing contingent featuresfor fracture fixation. Details of the contingent features include theproximal locking cap 23A-10 securing the inner core 23A-40 within thestem component of the humeral arthroplasty. The locking cap 23A-10 wasalso depicted in FIG. 20 . Further details for the stem componentrepresent a combination of the inner core 23A-40 combined with the outersheath 23A-10 50. The distal extent of the modified humeral stemcomponent 23A-60 includes a taper with a radius to expose the core tip23A-30. Finally, registration depiction 23A-20 represents registrationbetween the outer sheath 23A-50 and the inner core 23A-40 providing forpassage through the stem allowing for future fracture fixation devicesuch as screw or other securing mechanism.

FIG. 23B contains an overall representation of a reverse total shoulderarthroplasty in an alternative embodiment. Here the humeral articularsurface 23B-10 articulates with the glenosphere 23B-20.

In any of the embodiments herein, the sheath 23A-50 may be a unitarycomponent, or it may itself be a removable component. In the case of aremovable implementation, the sheath may be constructed with threads onits outer diameter that engage a corresponding threaded opening insertin a main body of another prosthesis or another periprostheticstructure. Those implementations permit subsequent replacement of thesheath 23-A.

FIG. 24 depicts a periprosthetic fracture below the humeral stemcomponent of a standard total shoulder arthroplasty. This embodiment nowdetails the removal of locking end cap 23A-10 to provide for removal ofinner core 23A-40. The distal extent of the outer sheath depicted at24-50 now has an opening for the acceptance of a modified inner corethat allows for fracture fixation and stabilization beyond the distalaspect of the fracture depicted at 24-60.

FIG. 25 represents an expanded view with complete removal of locking cap23A-10 as well as the inner core 23A-40 from the humeral stemcomponent/sheath represented at 23A-50. This overall embodiment detailsa standard total shoulder arthroplasty. Another embodiment may representa reverse total shoulder arthroplasty or some varying component ofshoulder arthroplasty.

FIG. 26 , again this is an embodiment of a standard total shoulderarthroplasty with a concomitant periprosthetic fracture. It is anoverall depiction of one embodiment of a medullary fixation device.Specifics for one embodiment include a locking bolt 26-10 providing forattachment of aiming arm/outrigger 26-60 interfacing through lockingwasher mechanism 26-70, to an underlying medullary fixation device26-30. Details of various embodiments of the locking mechanism forinterfacing 26-50 with 26-60 will be described in subsequent figures.The embodiment of the medullary fixation device here depicts aregistration 26-50 aligning with the intact humeral component sheath23A-50 at location 23A-20. This provides for insertion, in oneembodiment, of a locking screw for length and rotational control.Finally, the distal aspect of the medullary fixation device 26-30 isdepicted at 26-40. The ability for insertion of interlocking device, oneembodiment being a screw, allows for secure fixation of the distalaspect of the fracture below the intact humeral stem component andhumeral component sheath 23A-50.

FIG. 27 represents further detail of the assembly for the medullaryfixation device, with the components now being assembled through aninterface depicted at 26-70. This provides for registration androtational control as well as alignment between the medullary fixationdevice 26-30 and the intact humeral stem outer sheath 23A-50.

FIG. 28 shows the interface occurrence between the medullary fixationdevice 26-30 and the intact humeral stem sheath 23A-50. This interfaceoccurs through the vacated inner core of the humeral stem sheath 23A-50.The proximal extent of the interface is depicted as 28-20. The medullaryfixation device 26-30 now extends beyond the tip of the sheath 23A-50 tocross the fracture site into the intact distal humeral segment. The exitof the medullary fixation device 26-30 from the humeral steam sheath23A-50 through an exit annulus depicted at 28-10. Previously, the innercore protruded beyond the exit point 28-10 associated with FIG. 23A, nowthe medullary fixation device extends beyond the tip of the sheath23A-50 to include the intact distal extent of the fracture beyond thefracture line 24-60.

FIG. 29 depicts one embodiment of a standard total shoulder arthroplastywith final placement of the medullary fixation device 26-30. The devicedoes span across the fracture site at 24-60 exiting the outer sheathfrom the humeral stem at point 28-10. Continued registration ismaintained between the outer aiming arm 26-60 with the medullaryfixation device 26-30 through the locking screw 26-10. This provides forrotational control as well as distal alignment for targeting andinsertion of interlocking devices, one embodiment being an interlockingscrew. Coupling between the aiming arm and the medullary fixationdevice, representing the final insertion site, is depicted as aninterface represented at 26-70—distally, the humeral stem sheath.

The distal aspect of the medullary fixation device and the interfacelocking mechanism 26-70 are associated with FIGS. 36 to 43 . Details ofthis interface in various embodiments will be described to interfacewith medullary fixation device 26-30 specifics showing assembly of themedullary fixation device. Components would include humeral stem nowbeing exposed for future insertion of fracture fixation device cap23A-10 to provide for access to outer sheath 23A-50 and the inner core23A-40. This allows for passage of fixation device for potential futurefracture stabilization.

FIG. 30 shows another embodiment of a standard total shoulderarthroplasty containing contingent features for fracture fixationinterfaced completely with the medullary fixation device. An aiming arm30-30 now attaches to the outrigger 26-60 to provide for alignment andregistration for interlocking screws both proximal and distal to thefracture site depicted at 24-60. Cannula to align the registration areshown at 30-10. Alignment allows for the passage of a interlockingdevice, one embodiment being a screw, that passes through the outer bonecortex, the humeral stem sheath 23A-50 as well as the medullary fixationdevice 20-30. One embodiment of these contingent features showsalignment of the outer sheath 23A-20 with the intramedullary fixationdevice 26A-50. The distal extent of the fracture fixation embodimentshows the aiming arm 30-30 containing the aiming cannula 30-10 toprovide for registration and alignment allowing for the passage of ainterlocking device, one embodiment being a screw, through the outerbone cortex, through the distal aspect of the medullary fixation devicedepicted as 26-40, through the innermost cortex of the distal humeralbone.

FIG. 31 is an embodiment of a standard total shoulder arthroplasty withcontingent features for fracture fixation using a medullary based device26-30. Final insertion of the device across the fracture site isdepicted. The aiming arm 30-30 with contained aiming cannula 30-10 bothproximal and distal to the fracture site now has the ability foracceptance of interlocking screws depicted as 31-10. Features aredepicted showing registration and alignment between the aiming arm 30-30with inserted cannula 30-10 and alignment proximal to the fracture sitethrough the outer humeral stem sheath 23A-20 as well as theintramedullary fixation device 26-30 at the site through the medullaryfixation device 26-50. Distally, the registration alignment for passageof interlocking screws 31-10 occurs through the medullary fixationdevice 26-30 at holes 26-40.

FIG. 32 showing final insertion of interlocking screws 31-10 after finalinsertion of medullary fixation device 26-30, through the humeral stemouter sheath 20A-50. Distal interlocking screws are also depictedpassing through the medullary fixation device 26-30 at site 26-40.

FIG. 33A depicts the final fixation construct with aiming arm andoutrigger moved. This is for a standard total shoulder arthroplastycontaining contingent features. The proximal locking cap 23A-10 has nowbeen placed to provide for coverage over the medullary fixation device26-30 and the underlying humeral stem component screws 23A70. Oneembodiment of the proximal locking cap 23A-10 allows for alignment androtational registration between the intact humeral stem component 23A-70and the underlying medullary fixation device 26-30.

FIG. 33B represents an alternative embodiment of the humeralarthroplasty with contingent features for fracture fixation. Thisembodiment is described as a reverse total shoulder arthroplasty. Themedullary fixation component 26-30 passes through the humeral stemsheath placed at 23A-50 and traverses the fracture site for medullaryfixation. The previous embodiment detailing the assembly of theoutrigger 26-60 with the aiming arm 30-30 and alignment cannula 30-10 isequally applicable for the alignment and insertion of interlockingscrews 31-10 both proximal and distal to the fracture site at 24-60through the outer core.

FIG. 34 represents a reverse total shoulder arthroplasty with contingentfeatures for fracture fixation. This embodiment depicts anextra-medullary fixation device, that being a plate, depicted at 34-30.The outrigger/aiming arm 26-60 interfaces with the intact humeral stemcomponent comprised of outer sheath 23A-50 and inner core 23A-40. Theplate 34-30 attaches to the outrigger/aiming arm 26-60 using plateattachment device 34-20. The specific embodiments of the aiming arm30-30 and aiming cannula 30-10, as shown and/or described for previousfigures, allow for the passage of interlocking screws through theextra-medullary plate, 34-30 through the humeral stem comprised of outersheath 23 a-50 and inner core 23A-40. Distally distal to the fracturesite 24-60 are located screw holes 34-50 through the plate 34-30, onceagain allowing for alignment between the aiming arm 30-30, the aimingcannula 30-10 and the plate screw holes 34-50.

FIG. 35A depicts a reverse total shoulder arthroplasty with contingentfeatures for fracture fixation and a final assembly of theextra-medullary fixation plate 34-30 as well as the interlocking screwsboth proximal and distal to the fracture site 24-60. Screws pass throughthe plate 34-30 as well as the assembled humeral stem componentcomprised of outer sheath 23 a— and inner core 23 a-40, utilizinginterlocking screws 35-20. These screws, in one embodiment, provide forsecure fixation through structures allowing for alignment and rotationalstability between plate, bone and humeral stem. Distal to fracture site24-60 are also depicted interlocking screws passing through the plate34-30 and the underlying bone. These screws are depicted as 35-10.Finally, a registration screw 35-30 is located in the proximal portionof the humeral arthroplasty component passing through the proximalportion of the plate into the proximal portion of the intact humeralstem component. Design features may include, in one embodiment,appropriate threading to allow for intimate interface between the screw35-30 and the underlying proximal humeral component.

FIG. 35B shows an alternative embodiment for a standard total shoulderarthroplasty containing contingent features for fracture fixation. Anextra-medullary plate 34-30 is depicted to span the fracture site 24-60.Allowances for interlocking with registration both proximal and distalto the fracture site are noted. Locking screws 35-10 are aligned to passthrough the extra-medullary plate 34-30 and anchor into the bone belowfracture site 24-60. Proximal to the fracture site 24-60 are notedinterlocking screws 35-20. The interlocking screws 35-20 pass throughthe extra-5 medullary plate 34-30, through the underlying bone as wellas through the humeral stem component comprised of outer sheath 23A-50and inner core 23A-40. The distal extent of the inner core, 23A—40 isshown as 23A-30. The proximal extent of the extra-medullary fixationplate 34-30 is shown with an interfaced interlocking screw 35-30,extending into the proximal portion of the humeral component. Oneembodiment of this interlocking screw 35-30 is threaded to provide foran intimate interface between the plate 34-30 and the underlying humeralstem component 23A-70. It contains appropriate threat design to allowfor interface capabilities between the screw and the intact proximalhumeral component. Design features to allow for threading into theunderlying humeral fracture

FIG. 35C represents an embodiment of an alternative standard totalshoulder arthroplasty containing humeral head articular component35B-10, as well as solid shaft component 35C-10. The alternativeembodiment represents a solid humeral stem component 35C-10. Thisrepresents standard state-of-the-art humeral component structure withthe exception of contingent features 23A-10, representing a novelinterface for coupling an extramedullary aiming arm. One example of saidaiming arm is depicted at 26-60. Additional features allow forregistration and alignment of the extramedullary fixation device 34-30,with the solid core humeral component 35C-10 with similar interfacesallowing for passage of a screw through the extramedullary fixationplate 34-30 and the solid core stem 35C-10. The interface of theinterlocking screw through the solid core 35C-10 may be as depicted inFIG. 23A as 23A-20.

FIG. 35D represents an alternative embodiment for a reverse totalshoulder arthroplasty containing a solid core humeral shaft component35D-10 providing a similar unique feature for interface with anextramedullary aiming arm depicted at 23A-10. Extramedullary fixationplate 34-30 interfaces with the solid core humeral stem 35D-10, allowingfor passage of interlocking screws 35-30 and 35-20 at interface 23A-20.

FIG. 36 represents a disassembled embodiment of the modified prosthesiscomprised of parts 36-140 and 36-180. An alternative embodiment of solidcore 36-180 is also depicted at 23-40 in another embodiment. Proceedingfrom top to bottom, first depicted is a locking end cap 36-20, alsorepresented in another embodiment as 23A-10. Locking end cap 36-20contains a recess for a hex screwdriver 36-10. The threaded tip of thelocking end cap allowing for interfacing with solid core 36-180 isrepresented as 36-30. The interface for these screws is depicted as36-90. The locking end cap outer diameter 36-50 interfaces with theinterface nut 36-50 at the recess depicted as 36-70. Both the recess andthe outer diameter of the locking end cap are circular, thus allowingfor unencumbered rotation. Again, describing from top to bottom, lockingend cap 36-50 passes unencumbered through interface nut 36-50 throughopening 36-80. Additionally, locking end cap 36-50 passes unencumberedthrough registration of washer 36-120 through opening 36-130. Finally,locking end cap 36-15 interfaces with solid core 36-180 through a screwinterface between 36-30 and 36-90. This provides for solid coupling androtational registration. Moving down to interface nut 36-50, twoseparate recesses are noted, the first at 36-40, which is recessed hexinterface to accept a hex screwdriver. The second interface depicted as36-70 allows for free rotational interface with locking end cap 36-50.The threaded interface on the interface nut is depicted as 36-60. Thisthreads into the intact humeral component at interface 36-160. When thisinterface is fully engaged, it provides for registration between theregistration washer 36-120 and the intact humeral component 36-140 atthe registration slot 36-170. Additionally, the registration slot 36-170aligns with registration slot 36-100 as part of the solid core 36-180.Registration slot 36-170 together with registration slot 36-100 willreceive registration thin 36-110 of registration washer 36-120. Onceregistration thin 36-110 is inserted in the associated registrationslots and tightened utilizing tension and compression between lockingend cap 36-20 and solid core 36-180, rotational and axial registrationis maintained. Finally, humeral component 36-140 contains an additionalregistration 36-190 allowing for alignment and registration with aimingarm 26-60 in one embodiment. This registration would happen afterremoval of components 36-20, 36-50, 36-120, and solid core 36-180.

Turning attention to FIG. 37A, again the recessed end cap interface isdepicted as unassembled. Additionally, a cutaway diagram shows theinterface between the humeral component solid core 36-180 and thesurrounding humeral component 36-140. Registration slots are depicted as36-100 as well as 36-170. These registration slots are brought intoalignment with the use of the registration washer 36-120 and theunderlying registration thin 36-110. Further three-dimensional detailsof the registration washer are also depicted in FIG. 37C.

FIG. 37B shows a disassembled recessed end cap interface along with asuperior view of the humeral component comprising the outer solid body36-140 and the inner solid core 36-180. The superior view depictsnotches for the aiming arm registration at 36-190. The superior view ofthe registration slot between the outer humeral component core 36-140and the inner core component 36-180 is seen allowing for the acceptanceof the registration thin 36-110 as a component of the registrationwasher 36-120. The washer is compressed into place with the placement ofthe interface nut 36-50. The tightening of the interface occurs with theinsertion of a hex screwdriver at the hex notch interface of theinterface nut depicted as 37-60. Finally, the locking screw 36-20 isseen from a superior view noting the inner hex recess 36-10 allowing foracceptance of a hex screwdriver. The outer diameter depicted as 36-15interfaces with the underlying interface nut through the circularinterface 36-70. This provides for free, unencumbered rotation allowingfor threads 36-30 to tighten and interface with threads 36-90 of thesolid humeral core component 36-180. Tightening provides for solid axialand rotational control.

FIGS. 38A and 38B show further sequential assembly of the lockinginterface analogous to FIGS. 37A and 37B. The registration washer is nowshown registering with the intact outer humeral component and theinternal solid humeral core through the registration thin 36-110. Acutaway depiction is seen in FIG. 38A with the superior depiction seenin FIG. 38B.

FIGS. 39A and 39B illustrate further sequential assembly in both cutawayand superior views respectively. The interface nut is now inserted andtightened through screw interface 36-160 and 36-60. Insertion of theinterface nut and tightening occurs with the use of a hex screwdriverwhich interfaces at the hex interface 37-60. This is seen again cutawayview in FIG. 39A as well as the superior view in FIG. 39B. Of note, theinsertion of the interface nut now provides for compression andregistration of the interface washer with the intact humeral component.

Final assembly of the recessed locking interface is seen in cutaway forFIG. 40A as well as superiorly for FIG. 40B. The locking end cap 36-20is inserted with the use of a hex screwdriver at the hex interface36-10. It seats through a thread interface with the native threads ofthe end cap 36-30 interfacing with the outer threads of the solid corehumeral component 36-180 at thread interface 36-90. Of note in FIG. 40B,the superior view, is that the sequential final assembly is seen withthe outer registration end cap slot being unobstructed to provide forinterface with an aiming arm previously shown in one embodiment as26-60.

After reading the above text and inspecting the referenced figures, oneof ordinary skill in the art would now understand that interface detailsof FIGS. 36 through 40A and B respectively may be applied to other jointembodiments such as a knee, hip, or elsewhere and are not limited toembodiments of the shoulder alone. Additionally, one of ordinary skillin the art would understand these figures depict only one arrangementfor securing the solid core with the prosthesis body and otherarrangements may be employed without limitation. As but one example, onedepiction is now fully secure and threaded into position at interface36-30 with the solid core 36-60.

FIG. 41 shows attachment of an outer aiming arm 41-60 with a previousembodiment depicted as 26-60. The aiming arm is slotted to provide forregistration including axial and rotational control with the intacthumeral component 36-140 through slot 36-90. The elongated locking bolt41-10 passes through aiming arm 41-60 and the final assembly of therecessed end cap interface to thread into the solid humeral component36-180 with threads 41-20 and threads 36-90. Secure tightening allowsfor registration to occur at interface registration slot 36-190 of thehumeral component and tab 41-65 of the aiming arm.

FIG. 42 illustrates assembly of the aiming arm 41-60 with the intacthumeral component 36-140. Secure registration occurs with alignment ofregistration slot 36-190 with registration tab 41-65. Tightening of theelongated locking bolt 41-10 at thread interface 36-90 and 41-20 securesaxial and rotational control. In particular, this registration allowsfor axial and rotational control at interfaces 41-20 and 36-90. Thesecuring of the registration occurs with tightening of elongated lockingbolt 41-10 with the intact humeral core component 36-180 through screwinterface.

FIG. 43 is an alternative embodiment of the interface between outeraiming arm 43-60 and humeral component 36-140. The registration forrotational and axial control occurs at 36-190 and 43-65. Referencenumeral 43-40 depicts an aligning interface nut that provides for securefixation and registration between intact humeral component 36-140 andaiming arm 43-60. Free rotation of the aligning interfaced nut 43-40occurs at interface 43-70. Free rotation at this interface provides forregistration of the aiming arm as well as secure fixation of theunderlying registration washer 36-120, the intact humeral component36-140, as well as the solid humeral core component 36-180. Finally, analternative embodiment of the locking end cap is shown at 43-10. Theouter diameter of the locking end cap 43-10 is smaller than theinter-diameter of the aligning interfaced nut 43-40. The gap is shown as43-45. This provides for the ability to insert a hex screwdriver tointerface with 43-40 at the hex interface 43-75. For a hex interface43-75 to be unencumbered by the outer diameter of the locking end cap43-10. 43-40 represents an alternative embodiment of the interfaced nut.The interfaced nut provides for compression and secures registrationbetween the underlying humeral core component 36-180, the interface43-60 and solid humeral component 36-140. Interface between the outeraiming arm 46-36 and threads 36-120. Tightening of elongated lockingbolt 41-10 allows for secure registration, both axially androtationally, between aiming arm 41-60 and intact humeral component36-140.

FIGS. 44A and 44B show a telescopic hex fixation tool, including aninner core comprising a smaller hex diameter 44-10 with the proximalrounded shaft 44-15 exiting the outer hex component 44-20 throughinterface 44-18. The outer core hex component 44-20 interfaces to therounded shaft at 44-30. The rounded shaft 4430 is solidly coupled to thecore handle 44-50 at interface 44-40. The telescopic handle 44-60 isallowed to axially travel over the core handle 44-50 providing fortravel of hex component 44-10 into and out of the outer hex 4420 throughinterface 44-18. Inner body 44-50 at interface 44-40. The telescopichandle 44-60 may traverse a fixed distance.

Note that the provided descriptions of embodiments are for examplepurposes only to aid in the understanding of the use of the invention.The provided embodiments, figures and discussion should not be construedas limiting the scope or application of the invention contained herein.There are variations and modification to the specific embodimentsdescribed which are intended to be included within the scope of thisinvention.

It should be understood that processes and techniques described hereinare not inherently related to any particular apparatus and may beimplemented by any suitable combination of components. Further, varioustypes of general purpose devices may be used in accordance with theteachings described herein. It may also prove advantageous to constructspecialized apparatus to perform the method steps described herein. Theinvention has been described in relation to particular examples, whichare intended in all respects to be illustrative rather than restrictive.Those skilled in the art will appreciate that many differentcombinations of hardware, software, and firmware will be suitable forpracticing the present invention. Various aspects and/or components ofthe described embodiments may be used singly or in any combination. Itis intended that the specification and examples be considered asexemplary only, with a true scope and spirit of the invention beingindicated by the claims.

While this invention has been particularly shown and described withreferences to example embodiments thereof, it will be understood bythose skilled in the art that various changes in form and details may bemade therein without departing from the scope of the inventionencompassed by the appended claims.

What is claimed is:
 1. A prosthesis comprising: a joint interfacesurface, configured to articulate against a second joint interfacesurface; one or more contingent features integrally disposed on orwithin the prosthesis; a removable contingent component interfaced withat least one of the contingent features; and wherein the removablecontingent component is further configured to: provide access forinsertion of a fracture stabilization component within a medullary canalof a shoulder bone in which the prosthesis is configured to reside; andexpose the one or more contingent features for use in securing thefracture stabilization component with the prosthesis.
 2. The prosthesisof claim 1, wherein the removable contingent component is furtherconfigured to secure an aligning arm in mechanical registration withboth the prosthesis and the fracture stabilization component.
 3. Theprosthesis of claim 2, wherein the aligning arm is further in mechanicalregistration with both the prosthesis and the fracture stabilizationcomponent, and configured for aligning one or more screws with holes inthe prosthesis.
 4. The prosthesis of claim 2, wherein the aligning armis further in mechanical registration with both the prosthesis and thefracture stabilization component, and configured for aligning one ormore screws with holes in both the fracture fixation component and theprosthesis.
 5. The prosthesis of claim 1 wherein the fracturestabilization component further comprises a humeral sheath.
 6. Theprosthesis of claim 5 wherein the humeral sheath includes a vacatedinner core.
 7. The prosthesis of claim 5 wherein the humeral sheathfurther interfaces to a fixation device that extends beyond a distalextent of a humeral fracture.
 8. The prosthesis of claim 1, wherein atleast one of the removable contingent components includes one or moreinterfaces of the prosthesis.
 9. The prosthesis of claim 1, wherein thejoint interface surface is notched or keyed for rotational alignment insitu.
 10. The prosthesis of claim 1 wherein the one or more contingentfeatures include one or more of a pre-engineered notched interface, apre-engineered threaded interface or a pre-engineered keyed interface.11. The prosthesis of claim 1, wherein the one or more contingentfeatures are further configured to be located adjacent to a terminal endand within an outer surface layer of a bone within which the prosthesisresides when in situ.
 12. A shoulder prosthesis comprising: a jointinterface surface, configured to articulate in situ against a secondjoint interface surface of a companion joint structure; one or morecontingent features integrally disposed on or within the prosthesis; andone or more removable contingent components interfaced with at least oneof the contingent features, wherein at least one of the removablecontingent components is configured to be removable in situ to expose atleast one of the contingent features, so that the one or more contingentfeature is further configured to both: secure a fracture stabilizationcomponent with the prosthesis; and secure an aligning arm in mechanicalregistration with both the prosthesis and the fracture stabilizationcomponent.
 13. The prosthesis of claim 12, wherein the at least oneremovable contingent component is further configured to secure thealigning arm in mechanical registration with both the prosthesis and thefracture stabilization component, and to align one or more screws withholes in the fracture stabilization component.
 14. The prosthesis ofclaim 12, wherein the aligning arm is in mechanical registration withboth the prosthesis and the fracture stabilization component, andconfigured to align one or more screws with holes in the prosthesis. 15.The prosthesis of claim 12, wherein the aligning arm is in mechanicalregistration with both the prosthesis and the fracture stabilizationcomponent, and configured for further use to align one or more screwswith holes in both the fracture stabilization component and theprosthesis.
 16. The prosthesis of claim 12 additionally comprising: anextra-medullary fixation device comprising an aiming arm that interfaceswith an intact humeral stem component.
 17. The prosthesis of claim 16wherein the extra-medullary fixation device comprises a plate and aimingcannula.
 18. The prosthesis of claim 17 additionally comprising aproximal locking cap covering the extra-medullary fixation device. 19.The prosthesis of claim 12, wherein at least one of the removablecontingent components includes one or more interfaces of the prosthesis.20. The prosthesis of claim 12, wherein the joint interface surface isnotched or keyed for rotational alignment in situ.
 21. The prosthesis ofclaim 12 wherein the one or more contingent features include one or moreof a pre-engineered notched interface, a pre-engineered threadedinterface or a pre-engineered keyed interface.
 22. The prosthesis ofclaim 12, wherein the one or more contingent features are furtherconfigured to be located adjacent to a terminal end and within an outersurface layer of a bone within which the prosthesis resides when insitu.